Sepsis, Meningitis + Anaphylaxis paeds

Question 1

Meningitis pathology

Answer 1

Usually in first 5 years of life
Inflammation of leptomeninges surrounding brain tissue

Release of inflammatory mediators + activated leucocytes
Endothelial damage = causes cerebral oedema, raised ICP + decreased cerebral blood flow
Inflammatory response causes vasculopathy - causes cerebral cortical infarction
Fibrin deposits block reabsorption of CSF
Causes hydrocephalus

75% occur before age of 15

Question 2

Incubation period for bacterial meningitis

Answer 2

2-10 days

Question 3

Bacteria causing meningitis

Answer 3

Neonates = group B strep, E coli, Listeria
Infants + kids = Neisseria, strep pneumonia, Haemophilus influenza B
Adolescents = neisseria, strep pneumonia

Question 4

S+S meningitis (+ for ages)

Answer 4

Shock = tachycardia, tachypnoea, prolonged cap refill
General = fever, headache, photophobia, irritability, hypotonia, purpuric rash 
Infants = poor feeding, respiratory distress, coma 
Infants = lethargy, unsettled, refusing food 
Adolescents = muscle aches + pains, neck stiffness, N+V

Question 5

Kernigs + Brudzinskis sign

Answer 5

Kernig = child lies supine, hips + knees flexed, back pain on extension of knee

Brudzinski’s = flexion of neck causes flexion of knees + hips

Question 6

Complications of menigitis

Answer 6

Hearing loss 
Vasculitis 
Cerebral infarction = seizures 
Subdural effusion = especially H influenza 
Hydrocephalus 
Cerebral abscess

Question 7

Investigations for meningitis

Answer 7

Lumber puncture 
Septic screen
Bloods + glucose, lactate, cultures + gas 
Urine for M,C +S 
Nasal + throat swabs 
Viral/ bacterial PCRs

Question 8

Management of bacterial meningitis

Answer 8

<3 months cefotaxime + amoxicillin 
Ceftrixone >3 months
IM benpen in community 
Dexamethasone 
Rifampicin to family

Question 9

S+S neonatal meningitis

Answer 9

Bulging fontanelle

Hyperextension of neck (opisthotonus)

Question 10

Sepsis vs severe sepsis vs septic shock

Answer 10

Sepsis = infection + systemic inflammatory response 
Severe = sepsis + CV dysfunction/ acute respiratory distress
Shock = Severe sepsis + CV dysfunction

Question 11

Boundaries for tachycardia in children

Answer 11

<12 months = >160
12-24 months = >150
2-5 years = >140

Question 12

Food allergy cause

Answer 12

IgE mediated
Infants = milk, egg, peanut
Older kids = peanuts, fish

Question 13

S+S food allergies (IgE mediated vs not)

Answer 13

IgE mediated: facial swelling, anaphylaxis

Non IgE = D+V, abdo pain

Question 14

Pathology of anaphylaxis

Answer 14

Maldistribution of fluid
Allergen reacts with IgE ab on mast cells + basophils (type 1 hypersensitivity reaction)
Causes capillary leakage, mucosal oedema + shock

Question 15

Management of anaphylaxis

Answer 15

> 12 years = 500mcg IM adrenaline
6-12 = 300mcg
<6 = 150mcg

Question 16

Why is periorbital cellulitis a concern in children?

Answer 16

May be secondary to underlying bacterial sinusitis or due to spread from primary infection

Question 17

What are complications of periorbital cellulitis?

Answer 17

Sub-periosteal abscess, cavernous sinus thrombosis, intracranial abscess

Question 18

How to diagnose HIV in infants?

Answer 18

<18 mths = HIV DNA PCR

Over 18mths = detecting ab to virus

Question 19

Contraindications for LP

Answer 19

raised ICP,
thrombocytopaenia,
local infection at site of LP, extensive purpura
shock - stabilise first
after convulsions - stabilise first
respiratory insufficiency - stabilise first

Question 20

CSF results for bacterial meningitis

Answer 20

Cloudy/ turbid
High protein (>1)
Low glucose
Neutrophils present

Question 21

CSF results for viral meningitis

Answer 21

Clear fluid
Normal/ high protein
Normal glucose
Lymphocytes present

Question 22

CSF results for TB meningitis

Answer 22

Clear/ slightly cloudy
High protein >1.5
Low glucose
Lymphocytes + acid-fast bacilli present

Question 23

What infection is caused by herpes 4?

Answer 23

EBV

Question 24

What antibodies are involved in HSP?

Answer 24

IgA + IgG interact + deposit in organs

Question 25

What complication is associated with men B?

Answer 25

Febrile convulsions

Question 26

Which vaccines are live?

Answer 26

MMR + BCG – avoid in immunocompromised kids

Question 27

Describe the course of viral meningitis

Answer 27

starts with infection in mucus membrane, then lymph nodes, then causes initial viraemia then secondary viraemia (CNS infection)

Question 28

What pathogens commonly cause viral meningitis?

Answer 28

entero, parechovirus, herpes (worst)

begin acyclovir for herpes one

Question 29

What are the complications of meningitis + what measures are in place to detect these?

Answer 29

Septic shock, DIC, cerebral oedema, seizures
Long term: hearing loss, seizure, focal paralysis, cerebral palsy
All kids to have hearing test after 6 weeks from discharge

Question 30

Which organism causing meningitis has the highest mortality?

Answer 30

Pneumococcal

Question 31

What is the most common cause of meningococcal sepsis?

Answer 31

gram negative diplococci = Neisseria meningitis

Question 32

What are the early S+S of sepsis?

Answer 32

leg pain, skin mottling, cold peripheries, breathing difficulties
Haemorrhagic rash = >12 hrs into illness

Question 33

Late S+S of sepsis

Answer 33

Leaky vessels leads to poor perfusion so confusion, poor peripheral perfusion

Question 34

Complications of sepsis (early + late)

Answer 34

Complications = DIC, AKI, adrenal haemorrhage, circulatory collapse
Late complications = deafness, renal failure, scarring, amputations